The identification of antibodies and the provision of antigen-negative blood forms the basis for safe blood transfusion by minimizing the risk of adverse transfusion reactions, triggered when antibodies circulating in the patient's blood stream encounter antigens displayed on a donor's erythrocytes. Current practice in transfusion medicine provides for the serological typing and labeling of all donor blood for ABO and RHD antigens to facilitate the matching of red blood cell components to the recipient's blood type. The further reduction of allo-immunization remains an important clinical concern, and therefore it would be highly desirable to match additional blood group antigens. However, this practice is precluded by the lack of appropriate antisera, and the complexity of labor-intensive serological typing protocols, particularly when encountering multiple allo-antibodies. As a result, most donor centers screen only a selected cohort of donors and maintain limited inventory of antigen-negative units. This practice can introduce delays in treatment and thus create significant additional expense in patient care, and also can exacerbate emergency situations.
Comprehensive donor DNA typing of donors, as recently described (see Reid et al.; Transfusion May 2005) will enable donor centers to maintain a registry of prospective donors, and large and diverse inventories of fully characterized blood products available for instant shipping. In addition, the analysis of blood group genes at the DNA level provides a detailed picture of the allelic diversity that underlies phenotypic variability, an approach which helps in addressing clinical problems that cannot be addressed by serological techniques, such as determination of antigen types for which the available antibodies are weakly reactive, the analysis of recently transfused patients, or the identification of fetuses at risk for hemolytic disease of the newborn. Although the genotype may not reflect the phenotype, DNA analysis will identify the potential antigen-negative which, if desirable, can be confirmed by classical hemagglutination. Comprehensive DNA typing also can be extended to recipients and indeed can be applied population-wide by invoking practical methodologies, preferably eMAP™, performed on a BeadChip™ platform (See U.S. application Ser. No. 10/271,602, incorporated herein by reference).
Genetic Cross-Matching
A match, or near-match, between selected marker identified in a recipient, and in candidate donors of transfused blood—the markers corresponding to polymorphic sites located in genes encoding blood group antigens and specifically including minor blood group antigens—generally will minimize the risk of recipient immunization and, in immunized recipients, the risk of alloantibody-mediated adverse immune reactions following transfusion. That is, if the set of markers is selected to probe the relevant alleles associated with clinically significant hemolytic transfusion reactions (“allo-reactions”), then a comparison of markers of recipient and donor will permit the selection of donors that are genetically compatible with a given recipient. For example, each of a set of monozygotic twins, genetically identical, would be the ideal donor for the other. In the case of transfusion, the requirement of genetic identity—or near-identity—of recipient and candidate donor is limited to a set of relevant genes which—when expressed—encode certain human erythrocyte antigens (HEA) displayed on blood-borne cells against which the recipient either already has made (on the basis of earlier exposure) antibodies (“allo-antibodies”) or can make antibodies. Thus, markers correlating with human erythrocyte antigens (HEA) including the “major” antigens (A, B and Rh) as well as a number of clinically relevant “minor” antigens (e.g., Duffy, Kell, Kidd, M N S, Dombrock and others), as discussed in U.S. application Ser. No. 11/168224, are of interest.
The benefit of such a genetic cross-matching procedure will be to minimize or reduce not only the risk of adverse immune reactions, but also the risk of immunizing recipients in the first place, to eliminate the need for and to enable the rapid selection of blood products for transfusion from a group of registered and fully characterized donors, also referred to herein as a donor registry. Once fully implemented, genetic implemented, genetic cross-matching will eliminate the narrowing bottleneck created by the increasing cost of serological reagents and complex and labor-intensive protocols as well as the need for repeat testing.